Open AccessMicronized Palmitoylethanolamide: A Post Hoc Analysis of a Controlled Study in Patients with Low Back Pain – Sciatica
Author(s) -
G. Cruccu,
Giulia Di Stefano,
Paolo Marchettini,
Andrea Truini
Publication year - 2019
Publication title -
cns and neurological disorders. drug targets
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.923
H-Index - 86
eISSN - 1996-3181
pISSN - 1871-5273
DOI - 10.2174/1871527318666190703110036
Subject(s) - sciatica , palmitoylethanolamide , medicine , physical therapy , confidence interval , low back pain , anesthesia , neuropathic pain , back pain , placebo , receptor , alternative medicine , cannabinoid receptor , pathology , agonist
Background: Despite being widely prescribed, relatively few controlled trials have beenconducted on the class of neurotrophic/antinociceptive nutraceuticals. While performing a search inthe literature, we came across an old registration study on micronized palmitoylethanolamide in patientswith low back pain – sciatica by Guida and colleagues. Methods: We contacted the authors of the article and obtained all the original material, which allowedus to reanalyze the study. We assessed its clinical relevance by calculating the numbers needed to treatfor pain (visual analog scale) and function (Roland-Morris Questionnaire). After excluding patients forwhom the information available was insufficient, we assigned each patient to one of the five categoriesof increasing probability of neuropathic pain: pure lumbago, lumbago with projecting pain to surroundingregions (e.g. gluteus or groin), lumbago with projecting pain to the thigh or leg, pure sciaticaand radiculopathy, and investigated any correlations (Spearman) between the improvement in pain andfunction with these five classes. Results: Compared with placebo, palmitoylethanolamide 600 mg/die yielded a number needed to treatof 1.7 (95% confidence interval: 1.4-2) for pain, and 1.5 (95% confidence interval: 1.4-1.7) for function.The correlation between the five categories was highly significant for pain relief (P <0.0001),though not significant for reduced dysfunction. Conclusion: Palmitoylethanolamide was extremely effective on pain and function in a large cohort ofpatients with low back pain – sciatica. Although, the multiple mechanisms of action of palmitoylethanolamideare ideal for mixed pain conditions such as low back pain – sciatica, the correlation betweenpain relief and the likelihood of neuropathic pain suggests that this drug exerts a predominant actionon the neuropathic pain component.